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Not sure I understand this correctly

  1. #1
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    Richmond Virginia
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    Default Not sure I understand this correctly
    Exam Training Packages
    The NCCI edit manual states in chapter 9

    "If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an
    E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.
    *If a procedure has a global period of 090 days, it is defined as a major surgical procedure. If an E&M is performed on the same date of service as a major surgical procedure for the purpose of deciding whether to perform this surgical procedure, the E&M service is separately reportable with modifier 57. Other E&M services on the same date of service as a major surgical procedure are included in the global payment for the procedure and are not separately reportable. NCCI does not contain edits based on this rule because Medicare Carriers (A/B MACs processing practitioner service claims) have separate edits."


    THAT BEING SAID

    *****
    So does that mean if a Doc does a Consult and decides to put in a Port (36561)that consult would be inclusive to the Port that has a 10 day global?
    ***Also, what if you have a "major procedure" External Biliary drainage (47510) done the same day as a consult w/ a decision for surgery, do you append mod 25 or 57?
    I thought consult/procedure done same day it gets a 25 regardless....
    I think my answer is clearly here, just wanted others opinions!!

    Any help would be nice.

  2. #2
    Default
    The 57 modifier is used for decision for surgery-same day surgery- with a 90 day global period. The 25 modifier would be used if the surgery is on the same day with a minor surgery, which is a zero to ten day global.


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  3. #3
    Location
    Columbia, MO
    Posts
    12,570
    Default
    Quote Originally Posted by DnLJD0515 View Post
    The NCCI edit manual states in chapter 9

    "If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an
    E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.
    *If a procedure has a global period of 090 days, it is defined as a major surgical procedure. If an E&M is performed on the same date of service as a major surgical procedure for the purpose of deciding whether to perform this surgical procedure, the E&M service is separately reportable with modifier 57. Other E&M services on the same date of service as a major surgical procedure are included in the global payment for the procedure and are not separately reportable. NCCI does not contain edits based on this rule because Medicare Carriers (A/B MACs processing practitioner service claims) have separate edits."


    THAT BEING SAID

    *****
    So does that mean if a Doc does a Consult and decides to put in a Port (36561)that consult would be inclusive to the Port that has a 10 day global?
    ***Also, what if you have a "major procedure" External Biliary drainage (47510) done the same day as a consult w/ a decision for surgery, do you append mod 25 or 57?
    I thought consult/procedure done same day it gets a 25 regardless....
    I think my answer is clearly here, just wanted others opinions!!

    Any help would be nice.
    What this means is that every procedure has as a component of the procedure the assessment of the patient and the affected area necessary to perform the procedure. If that is all that was performed on the day of a minor procedure then the E&M is not significant and cannot be charged. (the provider cannot wear a blindfold and weld a scalpel) If on the other hand the assessment is beyond the scope of the procedure, such as doing a full body survey while examining a suspicious lesion, then you may use the 25 modifier.

    Debra A. Mitchell, MSPH, CPC-H

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